Staffing, whether insufficient in labor force or hours of care provided, was a common thread among 96% of states cited for poor nursing home care, according to a first-ever state-by-state analysis.

Only seven states provided more than one hour of professional nursing care per resident per day, notes Families for Better Care’s Nursing Home Report Cards.

With the goal of applauding states that provide good quality care, while motivating improvement for those that score poorly, Families for Better Care’s survey also ranked the top states for nursing home care as well as those posting “failing grades.”

Alaska (1), Rhode Island (2), New Hampshire (3), Hawaii (4) and Oregon (5) were among the top states scoring an overall “superior grade.” 

On the other end of the spectrum, the South accounted for much of the survey’s lower scoring states for nursing home care, with Texas (51), Louisiana (50), Indiana (49), Oklahoma (48) and Missouri (47).

Adequacy of staffing played a key role in determining state rankings, noted Brian Lee, Families for Better Care’s executive director. 

“A distinctive trend differentiated the good states from the bad states,” he said. “States whose nursing homes staffed at higher levels ranked far better than those with fewer staffing hours.”

The analysis, which scored, ranked and graded states on eight different federal quality measures—ranging from the percentage of facilities with severe deficiencies to the number of hours provided by caregivers per resident—found that states whose nursing homes employed an abundance of professional nurses and frontline caregivers translated to higher quality scores.

Ranking states according to this criteria, three states (Alaska, Hawaii and Maine) scored a “superior” grade in all staffing measures—each ranking among the nation’s best nursing home states. 

Conversely, the four states receiving below average grades overall for failing staffing measures were Georgia, Louisiana, Tennessee and Texas. 

“The data reflect what academicians, residents, families, and ombudsmen have heralded for years; the higher the staffing levels, the better the care,” Lee said. 

Widespread abuse and neglect was another area of concern recorded in Families for Better Care’s analysis, as 1 in 5 nursing homes abused, neglected, or mistreated residents in almost half of all states.

The analysis also sheds light on what it refers to as “abysmally low” health inspections, where the average percentage nationally was “scarcely over 30%.”

Coinciding with this finding, the data also show that nearly 90% of all nursing homes were cited for a deficiency.

“Slipshod care has festered for decades in far too many of our state’s nursing homes, culminating in to thousands of painful or deadly blunders for elderly and disabled residents,” said Lee. “It’s beyond time that states take a hard look at their nursing home care and figure out what’s working so residents receive safer, more affordable care.”

Written by Jason Oliva